*Job Summary*
The Utilization Management Specialist at Nevada Behavioral Health plays a pivotal role in optimizing the utilization of resources and ensuring the efficient and effective delivery of behavioral health services. This position is responsible for completing clinical reviews for behavioral health services, enhancing the quality of care, and ensuring compliance with regulatory standards. The Utilzation Management specialist will assist with streamling operations, improve patient outcomes, and maximize cost-efficiency while maintaining a focus on patient-centered care.

*Responsibilities*
* Utilization Management (UM): Complete clinical review and make recommendations for behavioral health services utilizing preferred care guidelines, ensuring that reviews are conducted effectively and efficiently.
* Quality Assurance: Monitor and evaluate the quality and appropriateness of services provided, making recommendations for improvements as necessary.
* Collaboration: Collaborate with embedded and community care coordinators to align UM recommendations and discharge plan for members in acute care.
* Compliance: Ensure compliance with all relevant laws, regulations, and accreditation standards.
* Interdepartmental Collaboration: Foster effective communication and collaboration between the utilization management team and other departments to ensure the seamless provision of care.
* Identify areas for enhancement and implementing best practices.
* Implement best practices
* Additional Duties as required.

*Skills*
* Proven experience in case management or a related field within a healthcare environment.
* Strong clinical skills.
* In-depth knowledge of utilization management principles and best practices in the behavioral health industry.
* Excellent understanding of regulatory and accreditation requirements.
* Strong interpersonal and communication skills for effective collaboration.
* Ability to make informed decisions and solve complex problems.
* Detail-oriented and well-organized with the ability to manage multiple tasks simultaneously.
* Exceptional critical thinking and decision-making abilities.
* Knowledge of electronic health record (EHR) systems and utilization management software.



*Years of Experience: *This position requires 2-3 years prior experience in utilization management.

*Education: *A masters degree in healthcare administration, nursing or related field.

*License, Certificate Or Registration: *Current Nevada licensure as an MFT, CPC, LCSW, or RN.

Job Type: Full-time

Pay: From $85,000.00 per year

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift



Education:
* Master's (Required)

Experience:
* Utilization review: 4 years (Required)
* Utilization management: 2 years (Preferred)

License/Certification:
* MFT, CPC, LCSW, or RN (Required)

Ability to Commute:
* Las Vegas, NV 89101 (Required)

Ability to Relocate:
* Las Vegas, NV 89101: Relocate before starting work (Required)

Work Location: In person